Provider Demographics
NPI:1629852611
Name:HIRSCH, MANDI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANDI
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20123 NE 19TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1610
Mailing Address - Country:US
Mailing Address - Phone:786-303-0703
Mailing Address - Fax:
Practice Address - Street 1:2555 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6250
Practice Address - Country:US
Practice Address - Phone:561-264-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN252711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics